Community Health Worker (CHW) /CHW Supervisor Training Inquiry for Individuals

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* 1. Name

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* 2. Title

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* 3. Organization/Agency/Company

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* 4. Email Address

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* 5. Phone Number

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* 6. Please select the type of training(s) you are interested in. (Select all that apply.)

CHW Core Training (100 hours)

CHW Continuing Education

Site supervisor and/or care team training on CHW integration

CHW recruitment and/or screening

Other (please specify)

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* 7. When do you anticipate needing training?

Within 3 months

Within 6 months

Within a year

Other (please specify)

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* 8. Please provide a brief description of your particular training needs. Include whether you work for an organization that will sponsor your training or whether you will be training as an individual.

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* 9. Where would you be willing to travel to attend training? Please select all that apply.

District of Columbia

Maryland

Virginia

None of the Above

If you require training outside of the District of Columbia, Maryland, or Virginia, please contact:
Dwyan Monroe at dmonroe@institutephi.org